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PubMed1996

Molecular analysis of glomerular diseases in renal biopsies: initial results of a collaborative international study. The International Study Group for Molecular Study of Kidney Biopsies.

An accurate assessment of which patient with glomerular disease will progress to end-stage renal failure would be an important addition to establishing prognosis and evaluating therapeutic strategies. We previously found the development of glomerular scarring in animal models was preceded by an increase in glomerular type IV collagen mRNAs and that the level of scarring predicted the rate of progression. The purpose of this study was to determine whether these findings apply to human glomerular diseases using microdissected glomeruli and assessment of mRNA by competitive PCR. After showing that the levels of type IV collagen mRNAs were elevated in sclerotic glomeruli isolated from nephrectomies, we undertook this preliminary cross-sectional study of type IV collagen subchain mRNAs in renal biopsies in two of the leading causes of glomerulosclerosis, diabetic nephropathy, and membranous glomerulopathy. We found that glomerular type IV collagen mRNA levels were altered in disease-specific ways. The relative levels of the individual alpha-chains of type IV collagen depended on the anatomic site of the glomerular lesions. The alpha 2 type IV/alpha 3 type IV collagen mRNA ratio was high in diabetes mellitus, but not in membranous glomerulopathy. These data, coupled with those obtained from experimental animals, suggest that a dysregulation of basement collagen synthesis underlies progressive glomerular scarring. If these conclusions are verified in prospective studies it will be feasible to assess the risk of developing progressive glomerulosclerosis in the individual patient and to quantitatively assess therapeutic responses in a timely manner.

Aged↗
PubMed1996

[Patients' attitudes towards and satisfaction with interns in general practice. Practicing interns and patient satisfaction].

The aim of this study was to evaluate the Danish vocational training scheme from a patient's point of view. This was especially interesting as all young doctors have six months vocational training in general practice after finishing university. During April 1993 junior doctors in twelve general practices in the county of Aarhus, Denmark, distributed a total of 574 questionnaires to consecutive patients after a consultation. The questionnaire was anonymously returned to the research unit. Four hundred and five patients answered the questionnaire. Ninety-three percent were fairly or very satisfied with the consultation, and 87% were sure or fairly sure that they would attend a trainee again. Eighty-five percent said that the trainee was as easy to communicate with as their own doctor. However, 36% said that attending a trainee was their only chance of seeing a doctor on the day preferred, and 47% did not feel fully informed about the trainee system. The data was analyzed with respect to sex, age, and disease related factors, and only minor differences were found. The survey shows that Danish patients were very positive about the GP trainee system, especially compared to previous investigations from other countries. However patients were not sufficiently informed about the aim and contents of the trainee system.

Attitude↗